Contribution of SWEET to improve paediatric diabetes care in developing countries

Pacaud, Danièle; Lemay, Jean-François; Richmond, Erick; Besançon, Stéphane; Hasnani, Dhruvi; Jali, Sujata; Mazza, Carmen

doi:10.1111/pedi.12427

Cited by 14 publications

(22 citation statements)

References 8 publications

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“…This level of care has devastating outcomes. There is a high early mortality from ketoacidosis at onset, because of misdiagnosis or late diagnosis, and later from hypoglycemia and ketoacidosis . There are also high rates of early complications, with devastating long‐term complications in some .…”

Section: Introductionmentioning

confidence: 99%

“…Mortality rates fall sharply as care (including management of diabetic ketoacidosis) begins to improve, and thus prevalence increases …”

Section: Introductionmentioning

confidence: 99%

“…2,4 These deficiencies in T1D care have profound impacts. Mortality rates are very high in children and adolescents, 5,[8][9][10][11] and for those who do survive, blood glucose control is poor and early chronic diabetes complications are frequent. [11][12][13][14][15][16] These stark differences in outcomes compared to well-resourced countries are tragic for patients and families and deeply distressing for health professionals.…”

Section: Introductionmentioning

confidence: 99%

“…There is a high early mortality from ketoacidosis at onset, because of misdiagnosis or late diagnosis, and later from hypoglycemia and ketoacidosis. 2,5,[8][9][10][11]21 There are also high rates of early complications, 12,14 with devastating long-term complications in some. 7,25 HbA1c levels are high in Tanzania, means of 14% (130 mmol/mol), 14 12.6% (114 mmol/mol), 12 and 12.3% (111 mmol/mol) 19 have been reported, and in India 13.0%…”

Section: Introductionmentioning

confidence: 99%

“…Once care has progressed from Level 1A to 1B or 1C, reported clinic mean HbA1c levels improve. For example, studies have reported 12.1% (109 mmol/mol) in Kenya, 22 12.0% (108 mmol/mol) in Ethiopia, 27 11.4% [101 mmol/mol] in Cameroon, 20 11.2% (99 mmol/mol) in Rwanda, 18 10% (86 mmol/mol) in Tanzania, 13 9.6% (81 mmol/mol) in Bangladesh, 28 and 9.8% (84 mmol/mol) 15 and 9.3% (78 mmol/mol) 4 in Sudan (note that two of these studies 4,27 are older papers from the mid 1990). Results will vary according to the particular country situation, whether improved care such as SMBG is available to all or some, and also the age distribution of the clinic population, as HbA1c tends to be higher in adolescents than in pre-pubertal children or adults.…”

Section: Introductionmentioning

confidence: 99%

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Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High‐income countries can usually provide this, but the cost of this care is generally prohibitive for lower‐income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower‐income countries work toward establishing guidelines‐based care, it is helpful to describe the levels of care that are potentially affordable, cost‐effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: “minimal care,” “intermediate care,” and “comprehensive (guidelines‐based) care.” Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra‐clinic mean HbA1c levels range from 12.0% to 14.0% (108‐130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64‐80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52‐69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

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Section: Introductionmentioning

confidence: 99%

“…Mortality rates fall sharply as care (including management of diabetic ketoacidosis) begins to improve, and thus prevalence increases …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

Patterson

Karuranga

Salpea

et al. 2019

Diabetes Research and Clinical Practice

435

316

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This article describes the methods, results and limitations of the International Diabetes Federation (IDF) Diabetes Atlas 9th edition estimates of worldwide numbers of cases of type 1 diabetes in children and adolescents. Methods: Most information in the published literature is in the form of incidence rates derived from registers of newly-diagnosed cases. After systematic review of the published literature and recent conference abstracts, identified studies were quality graded. If no study was available, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Estimates of incident cases were obtained by applying incidence rates to United Nations 2019 population estimates. Estimates of prevalent cases were derived from incidence rates after making allowance for higher mortality rates in less-developed countries. Results: Incidence rates were available for 45% of countries (ranging from 6% in the sub-Saharan Africa region to 77% in the European region). Worldwide annual incidence estimates were 98,200 (128,900) new cases in the under 15 year (under 20 year) age-groups. Corresponding prevalence estimates were 600,900 (1,110,100) existing cases. Compared with

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Diabetes in Youth

Kahkoska

Dabelea

2021

Endocrinology and Metabolism Clinics of North America

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Contribution of SWEET to improve paediatric diabetes care in developing countries

Cited by 14 publications

References 8 publications

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

Diabetes in Youth

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